WHO & G4 Poposals v4

Proposed Opportunities for WHO GEIESC & G4 Alliance Collaborations:

Funding Proposal Outlines

I. Integrating Surgical Care as Part of National Health Plans: A Six-Country Pilot

Background and Need

One of the most significant challenges to supporting implementation of World Health Assembly (WHA) Resolution 68.15 on Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage is to ensure that a standardized package of surgical and anaesthesia guidelines and services is integrated as part of national health plans. Further to implementing surgical care standards and guidelines, it will be critical to support adoption of an evidence-based surgical care package for district hospital facilities and to measure progress toward nationally identified standards.

Proposed Plan

The proposed pilot project will be rolled out in six countries, one country in each WHO geographic region. The goal of this initiative is to build proof of concept and evidence-base for a national implementation framework that draws from existing surgical, obstetric, trauma and anaesthesiacare standards and guidelines to create a comprehensive surgical care package for implementation at the district hospital level. To support sustainable implementation and adoption of surgical and anaesthesia care as part of national health care plans, we also recommend that this package include targeted monitoring and evaluation with the adoption of surgical care outcome metrics. By drawing from existing global standards and evidence-based resources, accompanied by effective outcomes monitoring, this proposal will create a comprehensive framework for national surgical care that would correspond with implementation of the WHA resolution. Figure 1 provides a proposed outline for the pilot project.

Why the G4 Alliance?

The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance) is comprised of over 60 leading organizations working in over 140 countries, including professional societies, non-profit organizations, academic institutions, social enterprises and foundations. This robust network brings together leading experts, practitioners and thought leaders who are united in their commitment to advocating for neglected surgical patients and to increasing access to life-saving and disability preventing surgical, obstetric, trauma, and anaesthesia care, focusing specifically at the district hospital level where the need is often greatest.

In 2015, the G4 Alliance’s member organizations began undertaking a consultative process to develop key framework elements to help guide the Alliance’s strategic action plan in support of advocacy, policy implementation and resource mobilization. As part of this process, the G4 Alliance’s Standards and Guidelines working group has initiated the process of developing a comprehensive framework for surgical, obstetric, trauma and anaesthesia care standards and guidelines, drawing from existing evidence-based, world-class resources. Concurrently, the G4 Goals, Targets, and Indicators working group has developed a framework of proposed indicators, drawing from the proposed Lancet Commission on Global Surgery indicators, and other cross-disciplinary targets and indicators endorsed by WHO and leading professional societies.

As a collaborative of member organizations working around the world, the Alliance provides a unique and advantageous opportunity to work through the G4 network to identify member organizations with strong in-country relationships with national governments, WHO representatives, NGO partners, and other key stakeholders to support successful implementation of the proposed pilot project.

Figure 1: Proposed Implementation Plan for Six-Country Pilot

Developing a Platform to Track Operative Case Log Data

Background and Need

Tools exist to gather health data at every level from household and patient to regional and global. However in order to capture surgical data on a globally relevant scale, it is only at the national level where consistent, large-scale operative data gathering is possible. At the facility-level individual operations and outcomes are being recorded. However, there is variability in how operations are recorded between countries and more broadly there is wide variability in how this data is aggregated at the national level. In order to support the development of a standardized platform for data collection to allow for widespread comparable data, it is proposed that a pilot project with selected countries is rolled out to ensure that the way operations are recorded at the facility level is standardized or can be mapped to a standard.

Proposed Plan

The G4 Alliance, in collaboration with the WHO, proposes to develop a consolidated platform for collecting operative case log data and, if possible, for tracking in-country training, activities and partnerships. Working closely with partners in WHO member states, The G4 Alliance (with the support of at least 3-5 member states) intends to initiate a formal request to the WHO to prioritize a comprehensive tracking platform. A proposal for funding in collaboration with the WHO would then follow, identifying the need for both academic and technical partners (including the World Bank, private foundations with in-country networks, etc.) to assist with implementation on the ground.

Along those same lines, the G4 Alliance proposes to implement a pilot study using an existing data collection tool – likely the open-source software DHIS 2. The G4 Data Platform to Capture Operative Case Log Data committee has been actively exploring the possibility of collaborating with COSECSA, RCSI, and other partners to test a roll out of operative case log data platforms using DHIS 2 in 3-5 countries.

Safe Surgery Summit in Collaboration with the WHO

Safe Surgery Summit

The G4 Alliance proposes to host, in collaboration with the WHO GIEESC and other strategic partners, a Safe Surgery Summit in 2017 that will be held in parallel with the next WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC) meeting. The Alliance may also collaborate with G4 member organizations The College of Surgeons of East, Central and Southern Africa (COSECSA) and/or the Pan-African Association of Surgeons (PAAS) to co-host the summit in an African country.

Outcomes

The goals of the Summit will be to provide support for the WHO GIEESC meeting and logistics, as well as to bring together experts and thought-leaders from around the world outside of the WHO GIEESC membership.